Provider Demographics
NPI:1578757407
Name:CHAPMAN, SUZETTE EDWIN (LMT)
Entity Type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:EDWIN
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:SUZETTE
Other - Middle Name:EDWIN
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICENSE MASSAGE THER
Mailing Address - Street 1:164 NE 167TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3403
Mailing Address - Country:US
Mailing Address - Phone:305-945-7246
Mailing Address - Fax:305-945-7246
Practice Address - Street 1:164 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3403
Practice Address - Country:US
Practice Address - Phone:305-945-7246
Practice Address - Fax:305-945-7246
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA32691225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA32691OtherMASSAGE THERAPY